The Present Illness

Telehealth Abortion under Attack, plus Bedside Betrayal in Canada Court’s Sloka Case

• Alyssa Burgart & Arghavan Salles • Season 1 • Episode 32

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5th Circuit Mifepristone chaos heads to Supreme Court; Canadian judge let’s off doctor for SA; Clit art; Golden Tempo; and bee huts!

Hunter Peterson tries to launch Spirit 2.0

Passengers stranded after Spirit Airlines shut down


Mifepristone

Bedside Betrayal: Jeffrey Sloka Canadian physician

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Credits

  • Production by Arghavan Salles & Alyssa Burgart
  • Editing by Alyssa Burgart
  • Music by Joseph Uphoff
  • Social Media by Arghavan Salles

Listen, that's what we do, okay? We know that y'all listen to us here because you're like, listen, tell me terrible news, but make it gossip. Yeah, okay, I'm ready. I'm ready to give you some gossip. Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that is definitely febrile and increasingly underdiagnosed. I'm Arghavan Salles a surgeon scientist, and your friendly neighborhood doom scroller in residence. And I'm Alyssa Burgart an anesthesiologist and bioethicist who tracks news and health law like they're EKGs, full of spikes and surprises. The present illness is where we dig into public health, politics, culture, and ethics with a scalpel in one hand and a meme in the other. As a note to new listeners, we often talk about topics that are intense, they can be a lot, so you may not want to listen to this with your little ones. big thank you to everyone listening with extra love to our subscribers and those who follow us on various platforms. A special warm welcome to anyone who just stumbled in from the shutdown of Spirit Airlines. Oh, R.I.P. Spirit, huh? Yeah, it's very sad. I have not had the pleasure of flying on Spirit, but they were in business for 34 years, not any casualties in that period of time. So one of the safest airlines we had despite all the jokes that people have made about them. um So, and I should say, they had filed bankruptcy previously and there had been an attempt at a merger with JetBlue. they already had financial troubles. And their um leadership has said that what brought them to this point now is the increasing fuel prices due to the unprovoked war on Iran by the United States. Well, I have uh had flights on Spirit. I can't say they were my favorite, but I definitely got where I needed to go safely. Like, I arrived. Well, that's what really counts. um I will say that we're recording this on Monday, May 4th. There is a development here that may have evolved by the time we post this episode. There's a young man on social media who has created a website and collected pledges for people to support this airline. So he's trying to prevent the airline from folding. and getting basically crowdfunding an airline. That's essentially what it is. So people have pledged millions of dollars altogether, which obviously running an airline is very, very expensive. So the pledges I think aren't quite there yet, um but there's quite a lot of momentum around trying to save the airline. So I'm curious to see, you know, what will come of that. Maybe it'll work. I don't know. We'll have the people's airline. Yeah, well, and my impression is that that's because, uh I believe and correct me if I'm wrong, that didn't the government offer to buy or bail out Spirit Airlines, but they were going to have to use the planes for military activity? Yeah, my understanding and uh I will fact check this after the episode, but my understanding is that the government had indeed offered a bailout for Spirit. The terms of that I haven't looked into deeply, but what I have heard was that there was a demand from the government that the planes be used, I think half of the planes or something like that be used for the military and that that was a line that Spirit was not willing to cross. so, If folks haven't been following, they announced at like 2 a.m. on whatever day over the weekend that they were shutting down basically effective immediately. So people who had trips that were coming up no longer had a ticket. They're supposed to be getting refunded. Some people were in progress of a trip, right? Like maybe they already were at their vacation destination or a meeting or visiting someone, whatever it was. And then their flight back was canceled because the airline no longer exists. And so everybody was scrambling to get rebooked. And so of course, United and American Delta were all having great times taking advantage of people who were desperate for flights. um I saw a flight that was that someone was searching for that was like $1,200, I think New York to the East Coast to the West Coast.$1,200 is uh a lot of money to just get across this one country when in a time of need obviously when people, due to factors outside their own control, all of sudden are stranded wherever they are. Nothing like price gouging people in crisis. Yeah, that's like quintessential America, really, if you think about it, and end stage capitalism. So anyway, my heart goes out to people who are affected, including the thousands of employees of Spirit Airlines. There was a clip of one of the pilots announcing on the plane as they were in the air that this would be their last, they were just informed that this would be their last flight and being grateful for the number of years they'd flown for the airline. It really is. I know people make a lot of jokes because of what Spirit Airlines uh was for a lot of people, but thousands of people became unemployed just like that. And then a lot of travelers were stranded or had their travel plans upended. it's pretty big catastrophe for air travel in this country. Also, from a safety standpoint, I don't feel like during a flight is a great time to tell a pilot that they don't have a job anymore. That seems like a terrible idea. The whole, mean, even just that sudden, the suddenness, I think, of the decision and the way that it was announced, which was primarily on social media. My understanding is that that's how employees found out was from social media. So anyway, it's a terrible, terrible situation. And I sure hope this guy, I'll put his posts in the show notes if people want to support, I hope he's successful in rescuing this airline, because it was really the only. somewhat reasonably priced airline for a lot of folks. So made air travel accessible to people who might not otherwise have been able to do it. Yeah, absolutely. Anywho, that's our brief little intro topic. It's not our main topic, but we're going go to you, Alyssa. What's the thing we should be talking about today? Listen, you know I love talking about abortion, love, love talking about abortion. um And there have been major issues going on. So. last Friday, literally as people were going home from work, suddenly there was this announcement that the Fifth Circuit Court of Appeals, which is a notoriously conservative branch of our judicial system, announced that they were going to uphold Louisiana's request to ban the ability for abortion medications in particular, pardon me, Mifapristone from being available by telehealth and from being able to be mailed. And the way that this was done was going to impose a nationwide ban on mailing abortion medications. And so huge tizzy on Friday, the manufacturers of Mifepristone, both the brand name manufacturer and the generic manufacturer made an emergency request to the Supreme Court to put a stay on that order so that we would not suddenly have literally over the weekend people who couldn't potentially get access to their abortion medication. The Supreme Court did. elect to put a stay. It is a temporary stay. It only lasts until probably next week. So y'all will hear this on a Friday and by the following week we expect there to be some additional information from the Supreme Court. So it's a temporary stay. This is a big problem. It's going to create a big problem if the court ultimately ends up upholding the Fifth Circuit's So we're gonna have to see what happens and what's especially frustrating is Mifepristone is like so safe. It's so safe. And that's why two thirds of abortions now are done using medication. Two thirds of abortions in the United States are medication abortions. They use a combination of Mifepristone with another medication and... uh solely using the other medication, misoprostol, is not as effective. And so it's really important to have access to both of these medications. And additionally, uh whether or not something's an abortion, mifepristone is just an important medication for physicians to be able to prescribe for a number of conditions, such as an incomplete miscarriage. And so the Louisiana group that brought this uh suit, eager to maintain their very strict ban on abortion and their claim is that the FDA having approved having access to Mifepristone without an in-person visit and then allowing it to be distributed not in person, so allowing it to be distributed by mail. uh was inhibiting their ability to maintain their abortion ban. no, people found a way to get around our draconian and inhumane law. We can't have that. That's what they sound like to me. Do you know why the Supreme Court stay is only for like a week? Yeah, so it's a temporary, it's a temporary stay. And the reason is basically that, so the Fifth Circuit, I don't know, for folks who have been paying attention, the Fifth Circuit is the most conservative judicial sector in the United States in our federal district courts. And the majority of the judges that are there in that district are conservative judges. There was a significant change that was made previously. It used to be that judges had to be appointed with a 60 vote majority, basically, in uh the Senate. And there was a change that was made, and I apologize, I don't recall what year it was, uh that made it so that you only needed 50 votes to approve a judge to be put into a position. And so the Trump administration and their first administration uh was very effective at placing a lot of conservative justices. The Biden administration was also able to put in some more liberal justices, but frankly, they were not nearly as effective. So the big change that we're seeing kind of play out here is that when you had to get 60 votes to approve a judge, there was really this bipartisan requirement that people couldn't be kind of too far right or too far left. And so what we have now is we have people who are far on, both spectrums. but many, many more conservative judges. So in the fifth district, they have been just causing chaos. That is like, they are the chaos machine right now of the judicial system. So it's having, even if you're randomly assigned a judge in the fifth district, because there's so many conservative justices there, you are highly likely to get a panel of conservative justices. And even if you get a less conservative justice for a first hearing, it can be sent to a panel where you're more likely to have three justices that are uh conservative or a full panel of justices that has to review a decision, for example, which there is a majority of conservative justices. So the Fifth Circuit's getting, they're doing all sorts of nonsense and there is a bunch of laws that have come, or a bunch of rulings, pardon me, that have come out of the Fifth Circuit that the Supreme Court has been like, you can't do that, you can't do that. And more, many of their uh rulings have, had to be overturned by the Supreme Court because they're just these chaos agents at this point. And so what Alito did when the decision went to him about this Louisiana case, by placing this stay, they can prevent the immediate chaos of suddenly having a nationwide ban on medication abortion, access to those medications, medication telehealth. By putting this stay, it give them, let's say, 10 days or however long to have all of the justices on the Supreme Court review the ruling and determine whether or not they're going to let it stand. I can't say that I have a lot of confidence in our current Supreme Court. um We'll have to see what they actually decide. But this temporary stay, first of all, very importantly, protects access to medication abortion by telehealth and by mail, at least for the next week or so. And we will hope to see the Supreme Court make a ruling that does not allow for the imposition of this ban across the United States. it flies in the face of the Dobbs decision, which Obviously, I disagree with that decision, but their whole point was to put control back in the states. And so to have one state be able to impose an abortion ban now nationwide uh flies in the face of at least what they claimed they were interested in in the Dobbs decision in 2022. Right, what they claimed I think is the key part of what you just said because we all, well not we all, but a lot of us knew that once that decision came down, the Dobbs decision, that the next step would be some way of creating a national ban without outright banning abortion nationally. And a lot of people thought it would come through essentially banning the mailing of Mifepristone through the Comstock Act. which is a very old, bill that has been on the books since I believe the 1800s. And it's about not being allowed to mail obscene things. this would be potentially considered, abortion medication could potentially be considered to fall in that category. That was one of the ways that people had theorized they might achieve this national ban. ask that the FDA reassess the safety data on mifepristone was another attempt at basically trying to get the FDA to say it's not a safe medication, so we can't have people have access to it anymore. That has not been a successful effort so far. I just talk about how stupid that claim is too, that it's not safe? It's so infuriating. It makes me so mad. It makes me so, so mad um because Mifepristone is like one of the safest medications that you can take and it is safer than pregnancy. And you you and I have talked before about, for example, you know, the maternal mortality crisis in this country. And so literally, if you just compare Mifepristone which has a very, very low rate of serious adverse events, less than 0.5%, so less than half a percent. And those complications that can happen, it's like you need a blood transfusion, you get hospitalized, maybe you need a D&C afterwards or a D &E, you may develop sepsis. But again, at a very, very low rate. The death rate is 0.65 deaths per 100,000 medication abortions. So again, incredibly low. Now for context though, for context, I love context. Like if you compare that to pregnancy, okay, so if you think about the deaths per 100,000 in the United States, pregnancy and childbirth in the United States carries a range, depending on where you're getting your care and what your race is, between 17 and 33 deaths per 100,000 live births in this country. And so, to, I mean, it is absolutely safer to take Mifepristone than to complete a pregnancy. And then the other thing that I think is very relevant is, you know, the leading cause of death for pregnant patients is they're murdered, oftentimes murdered by their partners. And so if you look, for example, at the firearm deaths in America, in 2021, there were almost 15 deaths per 100,000 people. Now, I didn't disaggregate that for pregnant people versus kids playing with guns versus homicide, but the death rate from firearms is deeply alarming. And so the idea that like Mifepristone is this like terrible scourge on the safety of women is totally absurd. um and yes, absolutely. What we know about gun violence is that it's the number one cause of death for children in this country. Not accidents, not cancers, not autoimmune anything, not chronic illnesses, as our Secretary of Health and Human Services wants to always talk about. Not infectious diseases, it's gun violence. And in cases of domestic violence, access to a gun increases the likelihood of an incident being lethal by five or six times. So yes, absolutely, if we want to care about the safety of women and in particular pregnant people, we should be thinking about gun violence. of course, no one in, well, I shouldn't say no one, but the people who have the majority in our government now and even when they didn't have majorities, would still vote the same way, refuse to do anything to restrict access to guns, even in ways that are very popular when you poll US uh citizens or people who live in the United States, that there are a lot of things, short of taking away everyone's guns, that people are in favor of, like closing loopholes on background checks and so on. I mean, we're not here to talk about gun violence today, but there's a lot of ways that that could be addressed if... People actually cared about the safety of women, pregnant people, and children. But we know for sure that that is not where the majority uh have their concerns. It's more in control, right? That's why they're going after things like Mifopristone. And it is true, I want to point out for our listeners, you can have a medication abortion with mesoprostol, the other medication alone, but as you said, Alyssa, it's less effective and more likely to have complications. But it is possible. to still have a medication abortion without Mifopristone. But of course, we prefer to have a safer option and a more effective option, which is using both Mifopristone and mesoprostol. And the government taking away access to one of those two medications is not going to help. It's going to hurt people um who need to have an abortion for whatever reason that needs to happen. And we've already seen that states have tried to go after physicians in other states who prescribed nifopristone for patients in a state like Texas, for example. And that's related to this ruling, right? That's who exactly they want to stop from being able to help patients in states where there are abortion bans. And I do wanna mention a couple other things about Louisiana. So folks may remember that in 20, because that's where this suit arose from, as you said. In 2024, legislators in Louisiana decided that embryos that are created from IVF are human beings, that they're children. And they put forward this bill that suggested that anytime an IVF clinic has to basically um destroy, is the word they use, that sounds very violent, but when there are embryos that they are no longer going to keep, that would be considered murder. uh Anyone who's gone through fertility treatments understands how nefarious that is as a concept because when anyone, a single person or a couple is trying to have a baby and they need to use IVF for whatever reason, you combine eggs and sperm and you get an unknown number of embryos. We cannot predict actually how many healthy embryos there will be. if a person, let's say it's a person or a couple and they want to have one child, maybe they get four or five embryos. Maybe they get more than that, who knows? You get some number of embryos. And then let's say they transfer the first one and they're successful. They have a great pregnancy. They have a live birth and they have their family. Now, what are they supposed to do with the other embryos? So historically, it's up to them. They can keep them. They can donate them. They can let them go. But what Louisiana tried to do with that bill was to say that anytime you don't use those embryos, that could be considered murder. And the consequence of that is basically shutting down IVF in that state, right? So the way some clinics responded was saying in the period of time where it was not clear what was gonna happen with that bill, the clinic said, well, you should store your embryos outside the state. That way you still have control over what happens to them. That's terrible for lots of reasons. Anyway, we're not here to talk, have a whole episode about IVF, but we could. um But the point is this is the place where this is happening. And it's also the place where the Voting Rights Act challenge originated that led to that disastrous decision from the Supreme Court last week. So I just want to, guess, shout out Louisiana for trying to restrict people's health care and human rights in multiple different ways. So good on you. I mean, and the other thing that Louisiana also did, which we like briefly mentioned on a previous episode, is they're the ones who uh indicted California doctor. I actually don't know how to say their name, uh Remy Coiteau, uh on felony charges because of mailing Mifepristone. So they're also trying to get, you know, Governor Newsom in California refused to comply with the request to extradite this physician. But, you know, Louisiana is getting real creative, real fast. Now the other, you want one more fun fact about safety, because you know, love a fun, I love a comparison. um So again, the risk of death from taking the Fepristone, super low. So small. So small. You But... Drugs that are PDE5 inhibitors, things like Viagra, death rates about 5 % of total adverse events in a study. That's 5,000 deaths per 100,000. Well, seems like we should be restricting access to those medications, don't you think? I think that that would make a lot of sense. um about the safety of older men. You know, and this is the thing, right? It's like, certainly some of those deaths are gonna be attributable to the population that needs to take them, but that's also why it's so important that the decisions for what medication should be available should be based on scientific evidence and not made by decree uh from some random panel of judges in, you know, the Fifth Circuit. Yeah, I mean, to state the obvious, like the FDA reviews medications for safety. So if a medication is not safe enough for a population to use, they're already supposed to block that, right? But we've had Mifepristone for decades because it is safe and that access has never been overturned on safety grounds because you couldn't make that argument because it's very, very safe. And these decisions about what medication is appropriate for a patient really should be made by a healthcare worker. in concert with that patient and what their medical conditions are, what their situation is and what their needs are. There is absolutely really no justification for legislators who are not physicians, who are not healthcare workers to be putting their religious views onto, which is often the origin of these types of things for abortion. These arguments start from a religious perspective and then they're trying to put that on everybody else and enforce that. in a way that makes absolutely no sense medically or scientifically and really shouldn't be allowed, but that's certainly what they're trying to do. And I was glad to see at least there's a stay of that decision in a way with the Supreme Court's announcement, but like you, that doesn't give me confidence that like seven days from now or 10 days from now or whatever, that they're gonna be like, yeah, we will support continued access to Miffl-Pristone via telehealth. uh We just, they've never, they have not given us reason to trust that they would do the right thing. So, so I don't. And in the meantime, we have, you I don't know how many thousands of women across the country or millions, I guess, probably who are pregnant and may right now be needing these medications and not be sure how they're going to get them or if they'll be able to get them after they, you know, they got an appointment with their doctor, but it's not until two weeks from now or whatever, you know, no one should have to be. in a position where they're going to be forced to be pregnant, which as you said, involves a lot more risk than taking them with your person or a misaprosel. No one should have to be forced to be pregnant because somebody in a black robe said so. time agree. Well, I'll keep you posted. I'm going to be following, following the story. Um, as I do just, we need some more wins for sure. We, yeah, we do. And I would like them to start sooner rather than later. I know a lot of people are talking about the midterms and I just, yeah, midterms are important. Everyone should vote, absolutely. Please vote. Yeah. and actually, because you were talking about personhood, I'll make sure to put this in the show notes. My friend Mary Ziegler, who's just a brilliant, brilliant legal scholar, one of the foremost abortion legal scholars in America, has a wonderful book that came out maybe last year. It's called Personhood, and it's all about the fight for fetal personhood. So if you want to nerd out on personhood law, it's a great book for that. I'll put a link in the show notes. no that's great and I wrote a piece with a colleague for Ms Magazine a few years ago that was also exploring different definitions of personhood and what might be banned or restricted based on these different definitions. So I can put a link to that in the show notes as well. I do want to say before we move on to the next topic that we people have been paying attention to what's happening with abortion who predicted that dobs would happen. have also for a long time been talking about and thinking about how they're going to be trying to restrict access to birth control. So for those who are following these stories, we are aware that's gonna be the next thing. And that's part of why we see these coordinated campaigns on social media trying to undermine birth control and suggest that uh the pill in particular, because there's multiple different forms of birth control, but that the oral contraceptive pill is unsafe, that it has all these terrible uh you know, unintended effects like women being able to have jobs and only have kids when they want to and like, can't have that. Exactly. um we're keeping an eye on all of that. um That said, shall we go on to our next topic, which is also really cheery? Listen, that's what we do, okay? We know that y'all listen to us here because you're like, listen, tell me terrible news, but make it gossip. Yeah, okay, I'm ready. I'm ready to give you some gossip. What terrible gossip am I going to hear today? It is truly terrible. So um we are starting a new series, which we have yet to name. Maybe we will by the time this episode is posted. But we're starting a new series about healthcare workers who do awful things. And um the first one, first installment of our series is today. We're starting with a man named Jeffrey Sloka, who is a former neurologist who practiced in Ontario in Canada. And There have been dozens of complaints about this man and in propriety with women patients. Back in 2019, he lost his license to practice. The College of Physicians and Surgeons in Ontario had gotten multiple complaints from patients. I'm gonna share some of those with you. So trigger warning for that. And then as... After that happened, more and more patients came forward because this is one of the things that we see all the time with sexual harassment and sexual assault is that often people think they're the only one and so they may not come forward because that's really scary. And anyone who has been around for a few years at least can see that in the media and on social media, anytime a woman comes forward, in particular a woman, but also actually happens to men who are survivors as well, anytime a survivor comes forward, Immediate reaction from the majority people seems to be well, what did they do to what did the survivor do to cause this? Or to not believe them. It's just so very hard to come forward So anyway, once once women who had been patients of this man saw that multiple women had come forward Then a lot more came forward and I believe there were at least 76 who had come forward and then there were 48 of them who were part of this lawsuit that was filed against him The decision came out for that lawsuit a couple of weeks ago and the judge, who's a man named Craig Parry, P-A-R-R-Y, basically said no, like he didn't believe that these women had been assaulted. These 48 women he did not believe had been assaulted. He believed that they had received medical care. And so I you to keep that in mind when I tell you some of the things that he did. and this is part of the College of Physicians and Surgeons investigation. There's four patients who were part of that investigation. The first one is patient A. Patient A was a teenager who was referred to this neurologist for assessment of seizures. This physician, well, I don't like to call him doctor anymore, but Slocca instructed, because I don't think he deserves that honorific, Slocca instructed patient A to remove her gown and stand before him facing a window in the examination room with her arms and legs out. Now, I just want to say that's not a normal part of a neurologic exam. And in fact, in no exam is a patient needing to be fully disrobed. standing in front of a window for inspection. Even when a dermatologist does a skin infection, I mean, sorry, skin inspection, looking for unusual moles, for example, they don't make you do that. They examine one part of your body, cover that up, examine another part of your body, cover that up. We're supposed to be respectful. appropriate exam only reveals the portion of the body that must be revealed for that portion of the exam, period. So that's the gist of the story with patient A. Patient B, in the case of patient B, says, Sloka sexually abused her by cupping each of her breasts separately, lifting them up and moving them without any clinical justification. Patient B was subjected to indignity of also standing naked uh while facing the window with her arms and legs spread. uh That was patient B. Patient C, was referred to Slocca for tingling from the waist down and at her first appointment he exposed and touched her breasts squeezing each one and yeah um that was not clinically indicated. um The patient D was a university student referred to Slocca because of a seizure and for just a second too, like, because breast exams are such an important, sensitive exam. And like, we learn in medical school how to do an appropriate breast exam. And it's like, there's a systematized way of doing it. It is not like, honka, honka. Like, that's not an exam. That's not an exam. I'm just, you know, bazanga, no. That's right. That's not how you do a breast exam. But also there was no indication for a breast exam for either of those patients. I'm not sure, maybe a neurologist can let us know, but I'm not sure when there is an indication for a neurologist to do a breast exam for a patient. if you had a, if your tingling, for example, was around a dermatome that was in your chest area, I could imagine there being a time when there was part of that. But again, none of that is what's coming out in this. Mm-hmm. Mm-hmm. So patient D uh was a university student referred to Slocca for a seizure. During a number of physical examinations, Slocca would slowly remove her gown by undoing the ties and letting the gown fall. Slocca examined her legs by bringing his face close to her body and getting onto his knees. He moved her breasts, squeezing and pushing them, including around the nipples. During a visit in which patient D had complained of twitching in her leg and back pain, I just want to say this is the most, uh this is the most violating of the things that I saw. So if people want to tune out for the next like 30 seconds, feel free. um Sloka inserted two ungloved fingers into patients, into her vagina while she lay with her legs flat on the table, he then put an ungloved finger or fingers into the rectum. The patient recalled, that he had touched her vagina and wrecked him in the same manner at subsequent medical appointments. um None of that, to be clear, is appropriate. There is never an indication for touching a patient in that way without gloves, for one thing, but also it does not seem indicated in that specific instance. I will say that it's relevant to note. that when he was asked about some of these things, you he said that he was doing a skin exam because he was looking for evidence of uh neurofibromatosis and yet did not chart in the patient's medical record that he had done a skin exam, thus undermining the reason for the exam. Not to mention that, of course, as we said earlier, that wouldn't be the appropriate way to do one anyway. But if really he was doing it for medical reason, then why didn't he chart that? in his notes and the same with the breast exams. He said that, you know, they were medically indicated, but then they're not documented in the visit notes, suggesting that he knew that what he was doing was inappropriate and was trying to get away with it and cover it up by not saying that he had done those exams. And so, yeah, 48 women came forward with their, you know, various experiences with this man and the judge went against what the College of Physicians and Surgeons had said and went against these 48 patients and said, yeah, I think that was just medical care. Now he's apparently written a 1,000, I think it's 1,002 pages decision to support this finding. uh I have not seen that publicly available. uh looking to and I haven't been able to find it. I will say that the way the um College of Physicians and Surgeons decision came about and what they wrote in their decision was that he agreed, SLOCA agreed to not apply for another medical license and would not be able to practice there. What is not clear to me is whether he can move to another province at this point and try to practice um or to another country, I suppose, potentially. I really hope that if he does do that, that the people have the wherewithal to be like, let's Google him. Mm-hmm. Yeah, and that he, I mean, you would like to think that he might respond honestly to a question of like, did he ever have his privileges revoked or whatever, but who knows if he would, I mean, you can't rely on people who are clearly doing unethical things to be ethical in that process. um hate all people who uh do sexual harassment and sexual abuse and sexual assault, like I hate them all. But there is a special, special hatred that I have for people who use their position of authority as a physician, as someone who has social standing in the community to use these exams as a guise and call it medical care is unforgivable as physicians, have so many fiduciary obligations to our patients. We have an obligation to care. We have an obligation to disclose errors. have an obligation to maintain confidentiality, informed consent. Like we have so many obligations to our patients because our primary obligations are to the patient. And so when physicians use that role, that very important role as a vehicle to abuse patients. just, it is unforgivable. Absolutely. And uh they did have as uh an expert witness in this trial, a woman physician who's a neurologist. And she said, these are not normal examinations to be part of these kinds of visits for patients who have these concerns, these seizures and the tingling and so on. um And so the judge even looked at her. and discounted her testimony as well. and this judge's ruling I mean I am deeply curious about the justification that this judge thought was acceptable and I am finding it very difficult to believe that it's gonna pass any sort of a sniff test. Yeah, I I think it is, I post about this on social media and people are calling for his hard drives to be searched. I mean, it does always make you wonder when you see a decision like this, that it seems like at least somewhat likely that this judge himself has engaged in inappropriate behavior and that's why he might see this all as perfectly fine, right? Because how else, I have a hard time understanding how else a person who is competent and can understand written and verbal information could hear about the things that I just read to you and more because there's many more patients who are part of this lawsuit and come away with a conclusion that it was just medical care. They did have a neurologist, woman neurologist as an expert in the trial who testified that this... I do not have her name in front of me. uh yeah, Dr. Vera Brill was the uh expert And I couldn't help but notice that she was a woman. I just couldn't help but see that, you know? you know, again, I'm so curious to see this ruling, and I really hope somebody makes it public, um or at least the parts of it that would not out these patients. Mm-hmm. It really looks like a male judge was totally fine with a male physician being like, no, this is totally A-okay. And then being like, you 40 plus people who are survivors, eh, you're not believable. the expert witness who is a neurologist saying these are not typical exams for this person's neurologic practice, she's not believable. I mean, it's outrageous and it just underlines again why people hesitate to come forward because can you imagine having already been assaulted by your physician, having mustered up the courage to come forward and talk about it, having talked to how, I mean, they must have talked to so many people, uh including lawyers and other people involved, investigators, whatever in this situation, and then testifying in court. Doing all of that with the hope of protecting other people from this person who harmed you only for a judge to say, actually, no, I don't think that what you experienced was bad at all. It's a second violation, right? And we talk a lot about institutional betrayal, people turn to the justice system. when there is a problem that they think needs to be addressed. And then when it's something like this, when you're violated in such a personal way and the justice system refuses to impose any sort of accountability, that's a second violation that can sometimes be even more damaging than the first because you really counted on this system to make a change. And then when it didn't, it hurts, it hurts a lot. So I think a lot of times people are, still even now in 2026 asking well why didn't somebody come forward why didn't they come forward in this specific situation like we saw it recently with the Eric Swalwell situation where a lot of people were like i just think it's suspicious why are they coming forward now why didn't they come forward sooner and if you don't know anything about survivors, I guess that's what you think. I mean, I guess, but survivors are also everywhere. There's so many of us. How do you not know anything about survivors? they were very clear, the women who came forward, that they came forward once they had heard there was someone else. And so, and I should just back up and say, like, what do you mean why now? I mean, he was running for governor of California. It's a pretty big deal. That is a perfectly reasonable time for someone to finally feel like, Maybe they have the courage to do it because they see what the consequences might be if they don't. And it's the same when you see people coming forward during a presidential campaign. It's the same reason because it's one thing. Sorry, go ahead. was just going to say like Christine Blasey Ford coming forward when it was like, yeah, Kavanaugh wants to be a Supreme Court justice. This seems like a good time to be like, do you have the values we want on this court? Yeah, because you know as a survivor, you know you're going to be put through so much when you come forward. So yeah, if the guy is, I don't know, working at the local Home Depot, maybe you don't come forward. But if that guy is going to be a state senator, maybe that's when you do you know what I mean? Like it makes perfect sense. But people are so eager to believe in conspiracy theories and to think that this was like some right wing plot in the case of Swablaw. This was some right wing plot to take him down. in reality, it was just that they finally heard that there were other women who had similar experiences and then felt brave enough to come forward. And even still, that's what happened with people questioning their motives and suggesting that they were being paid by some nefarious actors when instead they were doing actually a quite patriotic thing uh to say, want to protect this institution, the governorship of California. Like we shouldn't have someone like this in that position who can harm even more people from that position than he has. as a congressional representative. Anyway, all that to say, that's not dissimilar to what happens in healthcare where physicians have so much power and status relative to patients who come to us in their vulnerable moments. And I agree with you that it is particularly vile and disgusting to take advantage of those moments, which unfortunately you and I both know a lot of physicians do. um So yeah, that's our first installment. Yeah, and the other thing that I think is, I just want to touch on here is that, you know, medical exams are, even the most delicate well-done exams can still be invasive. They can still be really activating, especially for survivors. And this is why Stephanie Tillman, for example, as we've talked about before, does all this work around trauma-informed pelvic care, because we want physicians and midwives and nurses to learn how to do procedures in a way that we can support survivors and all patients in having exams that are medically indicated in a way that is safe and supported and does not re-traumatize or add trauma for these patients. And so I understand that having an indicated exam can be traumatizing and That doesn't mean that all exams are indicated. And I think this is a problem uh from talking with colleagues around the country who work in various parts of patient experience or in physician oversight and things like that. there's this false dichotomy that like, oh we decided the exam, know, patient brings a complaint, says I was assaulted by this person. And I think there's a default to say, well, the exam was indicated, it was a justified exam, and therefore it is impossible that it was assault, case closed. And that is a misunderstanding and a misapplication of what it means to support survivors. And... I think that we have done an incredible disservice to patients. mean, when you hear about so many of these patients being college students, being very young, patients don't know what to expect when they go for an exam. And so if you have this person of authority who's telling you like, well, yeah, of course, this is what I need to do for an exam. How are you supposed to know? And then if you have that repeatedly. The physician uh broadband in Utah, he very much took advantage of that. Robert Haddon, who Luke mentioned before, I mean, we'll revisit these folks, but Haddon definitely did that too. He took advantage of patients not knowing what to expect and did really completely inappropriate, it's not a strong enough word, but things to them. because he knew they wouldn't necessarily know better and he was counting on them not talking to anyone about it, which happened I think a lot of cases. That's why he got away with it for so long and that's why men like this do get away with it for so long. um It's just really, really shameful that in this case with so many women sacrificing and coming forward that the judge still said, I think this is okay. So hopefully, as I said earlier, the College of Physicians and Surgeons ruling will. prevent him from being able to practice, you never know. If he moves somewhere else, it's hard to know if people ask the right questions. He's certainly not gonna offer up the right information. anyway. oh Well, thanks for educating us on the horrible gossip from Canada. Yes, and I do want to point out like the reason we want to talk about this is not to just bump people out but to raise awareness of the fact that this does happen and know physicians even still enjoy largely a positive reputation despite you know all the anti-vaccine sentiment and so on and and There are bad actors in medicine as there are in every other profession and it's really important for patients to know that we don't co-sign that behavior and to talk about what is a normal exam and what is not a normal exam I think is really helpful. So anyway, enough of that one for today. Shall we talk about take two and call me in the morning? What is your recommendation? Absolutely, so my prescription for folks, there's this lovely artist who was brought to my attention, name's Sophia Wallace, and she makes a bunch of clitoris art. um There's some really cool sculptures that she's made, some of have been turned into jewelry, she's got some really cool prints, um and she's just really exploring the female form from her perspective. and I heard through a friend about some art that she's working on that should come out sometime soon. So I'm following her Instagram. I'm really excited to see what she puts out. And then the other thing is when I was traveling recently, was very, very fortunate and a friend invited me to stay in Oahu in Hawaii. And on her property, she has these things that she calls them bee huts, um which like, like the concept of a bee. Okay. Like I like honey. I like the idea of a bee, but I'm not like, let's hang out with bees. I'm not, I've had some, I've been stung before. But she has this really cool thing set up where they have beehives for their farm and the over the hives they've built sort of like, like a yoga hut sort of thing. There's like, it kind of looks like if you went into, um, like a sauna where it's all wood on the inside, but it's not hot. It's like a pleasant experience. And they've got the beehives covered in like steel mesh. So the bees are not in the room with you, but you can hear them buzzing and they buzz at this like very pleasant C note, um, or a little bit of a B flat maybe, but it sounds really lovely. And the other thing is she was like, oh, and you'll breathe so well when you're in there. And I was like, okay, sure, whatever. And then I got in there and I was like just laying in there for a little while to just see what it was like. And, you know, I was trying to really suppress my thoughts of, you know, the My Girl movie that traumatized me as a child, where Macaulay Culkin gets stung by a bunch of bees and dies. But anyway, I ended up laying in there for a while and I... I ended up just taking these like really big sigh breaths that just felt really good. And I don't know what it is about the bee pollen that's in the air. Like the air is kind of like a little bit sweet tasting. I don't know. It was very pleasant. And by the end of the week, I felt kind of attached to the bees. I was like, I'm going to go visit the bees, which I was just very unexpected. I loved it. Um, so I'll put a link to just be Hawaii, um, in the show notes. So if any of you happen to be going, to Hawaii, you should think about booking some time in the bee hut and you can enjoy the pleasant humming of bees and get some nice deep breaths. Well, Arghavan what do you prescribe? Yes, the thing that I wanted to talk about today is the Kentucky Derby was this past weekend and Cherie DeVaux is the trainer for the horse that won and she is the first woman trainer whose horse has won the Kentucky Derby in all these bazillion years. Yes, in the 152 years of the Kentucky Derby. and she yes, so go Sherry or Sherry. I'm not sure how it's pronounced. C-H-E-R-I-E. And she had, you know, had a love of horses, but originally was working under other people. And according to this report, I saw her husband was the one who encouraged her to go out on her own and start training horses on her own. once she did, she was very successful. Like horses kept winning and winning and winning. Um, so there's a clip of her that I really recommend folks to watch. I'll put it in the, in the show notes, but while she's watching the race now, her horse, if people don't know and didn't follow this horse was at the back of the pack, like dead last. um And in the kind of last turn, turn and a half just took over and ended up finishing first. And so you can watch her reaction as she's watching him like gain and gain and gain and gain until he finally wins. And it's so special and joyful. um And so congratulations to her and for her husband believing her and giving her the nudge to go out on her own. um really special moment for anyone who cares about women's sports. Fantastic. And okay, I want to add one little factoid about the Kentucky Derby that I hope is true. I just read it. that 29 of the 30, you never know anymore with the internet, the 29 of the 30 horses that raced in the Derby were apparently descendants of Secretariat. Oh, mm-hmm. I mean, that's a wild dynasty, 29 of 30. That's dominance. Let's like, we have no human similar achievement, right? Like if you look at the greatest basketball teams, the greatest football teams, like nothing like that. 29 of 30, if that's true, I'll double check it. But that's pretty impressive. Anyway, that's it. up the winning horses name, Golden Tempo. That's right, golden tempo. um Anyway, I think there are some, I need to look into this more. I think there are some criticisms of the Kentucky debris as probably there are with all horse racing. um We are opposed to animal cruelty here, but just was a special moment to see her success. uh Anyway, with that, I think that's it for this week's episode. If you didn't like what you heard, this has been the Wellness Unmasked with, sorry. That's it for this week's episode. If you didn't like what you heard, this has been Wellness Unmasked with Dr. Nicole Sapphire. If you liked it, don't forget to subscribe to The Present Illness, leave us a review, and importantly, please tell other people to listen. We know that you care deeply about who the next surgeon general will be. So go ahead and follow us on TikTok, Instagram, and YouTube at The Present Illness, and you can stay on top of all of our TPI related news. We will be back next week with more headlines, hot takes, and doom scrolling wrapped in some laughs. Until then, agitate, hydrate, take a nap, and we'll see you next time on The Present Illness. Production by Arghavan Salles and Alyssa Burghardt, editing by Alyssa Burghardt, social media by Arghavan Salles, original music by Joseph Uphoff. Don't take medical advice from random people on a podcast. This shows for informational purposes. It's meant to be fun, and it's certainly not medical advice. Please take your questions to a qualified professional.

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Alyssa Burgart, MD, MA

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Arghavan Salles, MD, PhD

Host